Thread by @Jhagra

🧵. One of the most significant #KPHealthReforms is the outsourcing model to run dysfunctional hospitals, in particular in far flung areas of KP; this thread describes the transformation in 19 hospitals across ex-FATA, Chitral & Kohistan, and the outstanding results achieved.

2. Govt hospitals will not work in the traditional public sector model in the periphery, across Pakistan.
Doctors do anything to be transferred out; hospitals become full of lower staff hired by politicians; infrastructure is typically abysmal because of complex budget processes.

3. Outsourcing changes that!
The results in the first 8 outsourced hospitals tell the story. From just 15 doctors & nurses before outsourcing, to 212 after, in some of our remotest districts:

0 to 41 specialists
13 to 86 doctors
2 to 85 nurses

4. Result for patients: around 750 patients access these hospitals everyday, up from 250 per day before outsourcing:
- From 9 emergency patients per day across 8 hospitals to 147.
- From 0 IPD (inpatient) to 78 per day.
- From daily OPD of 245 to 516.

5. Very similar results obtained in the second set of 11 hospitals to be outsourced;
From only 5 specialists and 70 doctors & nurses before outsourcing, to 39 specialists, and over 300 doctors and nurses after outsourcing...

6. ...resulting in an increase in patient load from 600 per day to almost 2400 per day, across the 11 hospitals; in-patient usage increasing from 5 per day to 117 per day.
For the first time, hospitals in far flung areas have started to be truly functional.

7. Outsourcing has vastly improved infrastructure and processes at each of these hospitals; back up power; biometrics; infectious waste management systems all added.

8. Pictures speak louder than words.

THQ Dogar, District Kurram.
Before & After

9. Mamad Gat Hospital
District Mohmand

One of the most impressive facilities, that would beat similar hospitals in most developed urban areas of Pakistan.

10. In District Orakzai, 3 outsourced hospitals including the DHQ, Mishti Mela and Ghiljo provide services through an outsourced model.
The DHQ has been declared one of KP's best, and the other two hospitals, previously ghost hospitals pre-merger, now provide extensive services.

11. Toi Khula & Sholam in S. Waziristan along with the DHQ (not in picture) are all outsourced.
When I visited Sholam hospital, I was amazed to see a gynaecologist from Karachi & staff from all parts of KP & Punjab; in the traditional public sector model, this could never happen!

12. THQ Hospital
South Waziristan
Before and After.

13 Category D Hospital
FR Darazinda, Dera Ismail Khan

This hospital sees patients from as far as Zhob in Balochistan. Again, on a visit with @AliAminKhanPTI, was proud to see the quality of services being provided in exceptionally remote areas, & staff from across KP & Punjab.

14. In our view, while outsourcing should be a key part of our health system, this does not mean that we don't improve our other hospitals. Significant work has also done there.
But because outsourcing challenges the monopoly of civil servants over delivery, it faces opposition.

15. Credit for managing outsourcing transparently goes to the excellent board at Health Foundation led by Dr Aman.
Pakistan needs to explore such models in health & education at much larger scale. Govt's job is to provide service to the masses, not employment to a select few.

16. A 76 page comprehensive comparative study & audit of outsourced hospitals versus similar hospitals running through a traditional public sector model proves the vastly superior delivery of the outsourced model.
Available on the @HealthKPGovt website.
healthkp.gov.pk/public/uploads…